Policy Report Lessons Learned: How the Partnership for a Healthy North Carolina Avoids Kentucky’s Medicaid Reform Mistakes

7/28/2019 Policy Report Lessons Learned: How the Partnership for a Healthy North Carolina Avoids Kentuckys Medicaid Ref

1/16

How the Partnership for a Healthy North Carolina Avoids

Kentuckys Medicaid Reform Mistakes

Lessons Learned


2/16

LessonsLearned

HowtHePartnersHiPforaHeaLtHynortHCaroL

avoidsKentuCKysMediCaidreforMMista

JonatHaningr

KatHerinerestr

JuLy20

Contents

3 Executive Summary

4 Overview

Learning from other states

5 The Partnership for a Healthy North Carolina reduces administrativ

burdens aficting Kentucky providers

6 The Partnership avoids the payment delays Kentucky providers face

7 Louisianas Bayou Health protects providers from payment delays

The Partnership develops strong provider networks through thought

implementation

8 The Partnership features leadership with the critical experience

Kentucky lacked

The Partnership helps ensure managed care organizations cannot ho

the state hostage like they can in Kentucky

9 Conclusion

10 End Notes

14 About the Authors

15 About the John Locke Foundation

This is a joint publication of the Florida-based Foundation for Government Accountability and the North Caro

based John Locke Foundation. It appears as Policy Brief #7 for the Foundation for Government Accountabi

Medicaid Cure initiative, and as a Policy Report for the John Locke Foundation.The views expressed in this repor

solely those of the author and do not necessarily reect those of the staff or board of the John Locke Foundation

more information, call 919-828-3876 or visit www.JohnLocke.org.

2013 by the John Locke Foundation.


3/16

LESSONS LEARNED

P O L I C Y R E P O R T

Executive Summary

Governor Pat McCrorys Partnership for a Healthy North Carolina is an innovative approach to

redesign the states old Medicaid system into a safety net that improves patients health and saves taxpayer

dollars.

The Partnership builds upon powerful patient-centered reforms already working in other states.

Key features of the Partnershippatient choice, competition among private plans, funding strategies

that prioritize patient health, and streamlined billing systemsare succeeding in Florida, Kansas, and

Louisiana.

The McCrory administration wisely embraced proven strategies to develop the Partnership. But it

also paid close attention to why managed care reform efforts faltered elsewhere, particularly in Kentucky.

In 2011, Kentucky transitioned to a statewide Medicaid managed care program. Unfortunately, an ill-

conceived implementation timeline and the absence of key provisions resulted in several complications

for patients, providers, and policymakers. These include:

Senseless administrative burdens aficting providers abilities to practice efciently

Lengthy payment delays to doctors and hospitals

Poor implementation strategies resulting in failed development of provider networks

This report examines these and other mistakes that left Kentucky with a botched Medicaid reform. It

also explains the strategies and provisions included in the Partnership for a Healthy North Carolina that

help to ensure North Carolinas patient-centered Medicaid reform does not replicate Kentuckys failings.


4/16


5/16

LESSONS LEARNED


Risk-bearing managed care organizations serve most of Kentuckys Medicaid program, although some

populations and benets are carved out.9Kentucky contracts with three managed care organizations in seven of its

eight Medicaid regions and with four managed care organizations in the remaining region.10

The Partnership differs dramatically from Kentuckys traditional Medicaid managed care experiment. The

Partnership features protections and common sense strategies that help guard against many of the problems

Kentucky faced in its implementation of traditional managed care. Patient-centered Medicaid reforms in FloridaKansas, and Louisiana, which serve as models for the Partnership, incorporate relatively simple measures that

safeguard against the kinds of challenges faced in Kentucky.

thePartnershiPforaheaLthynorthCaroLinareduCesadministrativeburdensaffLiCtingKentuCKy

Providers

One of the earliest reported problems with Kentuckys transition to traditional managed care was the complex

administrative burden placed on providers. Providers reported confusion about processing claims, as each of

Kentuckys Medicaid managed care plans had its own coding and billing system that differed substantially from

the system previously used by the traditional Old Medicaid program.11

Providers accustomed to billing for each 15-minute increment of a visit soon discovered the health plans

expected them to submit one single bill for the entire length of the patient visit.12There was also confusion about

specic billing codes and modiers, creating unnecessary frustration for providers and plans alike.13This confusion

led to early problems, including initial reimbursement denials and reductions.14

The Partnership for a Healthy North Carolina addresses this potential problem in its outline of how the redesigned

Medicaid system will operate. The Partnership requires all CCEs use the same nancial vendor for reimbursement

North Carolinas Medicaid Management Information System (MMIS).15A consistent billing system alleviates

much of the hassle providers experience as they bill different plans for the care they provide.

Kansas patient-centered KanCare reform did something similar, giving providers the option to use KansassMMIS to submit claims to KanCare managed care organizations.16To further maximize providers time and ability

to practice, North Carolina may wish to follow Kansass lead and give providers a choice of either the MMIS or

the CCEs billing systems, as some physicians may be more familiar with the commercial billing systems or nd

them more user-friendly.

North Carolina is also modernizing its MMIS with NCTracks, an improved claims processing system that

launched in July 2013.17The improved system will provide 24/7 access to MMIS, enable electronic submission

of all claim types, fully support electronic funds transfers of claims payments, and consolidate claims processing

activities for multiple health plans.18

The NCTracks project began in 2008 and was originally scheduled to go live in August 2011.

19

Numerousimplementation issues delayed the project and an auditors report found that the Perdue administration lacked

adequate controls to address those delays.20These delays have caused the project to cost twice what was originally

expected.21

The current administration inherited the project when Gov. McCrory assumed ofce in January 2013. An audi

of the systems readiness in February 2013 found that 285 of the 834 system tests that were deemed critical

had not yet been performed.22The audit also found that of the 549 critical system tests that had been performed

NCTracks had failed 123 of them.23


6/16

6

J O H N L O C K E F O U N D A T I O N

LESSONS LEARNED

The audit provided the North Carolina Department of Health and Human Services with a number of

recommendations to ready the system by its revised July launch date.24Senior staff have been busy implementing

those recommendations and performing other readiness activities in preparation for launch. According to the state

auditor, the Department has mitigated several of the problems identied in February and has been working to

mitigate the remaining issues before the July launch date.25

NCTracks should be fully operational well before implementation of the Partnership for a Healthy NorthCarolina. By allowing providers to use the improved MMIS system for reimbursement, the Partnership eliminates

the frustration and confusion about claims processing that Kentucky providers endure.

thePartnershiPavoidsthePaymentdeLaysKentuCKyProvidersfaCe

Perhaps the single largest problem resulting from Kentuckys shift to traditional managed care was longer

payment delays to doctors and hospitals, especially in the early months. In the rst quarter of 2012, the Kentucky

Department of Insurance cited two of the three health plans for failing to pay providers claims promptly. 26Some

providers sued the health plans, claiming they had been waiting more than a month for the vast majority of their

unpaid claims, and more than three months on many of those bills.27

These delays were largely caused by billing system issues and by the fact that, in some cases, the managed

care organizations had not nalized contracts with providers before the open enrollment period.28One managed

care organization also claimed the state provided it with false cost and utilization data during the bidding process

causing it to underbid and lose $120 million in the rst year, leading to further payment delays. 29

This led to a preliminary audit of the plans.30The auditors report highlights how Kentucky failed to establish

a proper Medicaid reform framework. For example, the state had not developed adequate metrics to measure the

timeliness of provider reimbursements.31The auditors report also criticized state ofcials for failing to establish

procedures for reporting those metrics or resolving payment delays.32

Kentuckys Medicaid agency reports that payment delays have signicantly improved since the transitionperiod.33State ofcials report that approximately 78 percent of the 28 million claims led during the rst year

of implementation had been approved and paid, with 99 percent of approved claims being paid within 30 days. 34

Many of the remaining payment denials or changes relate to improper billing codes.35

Nevertheless, the Kentucky governors ofce has promised that the states Department of Insurance will review

payment disputes between providers and managed care organizations.36It has also promised to launch targeted

audits of the managed care organizations for claims processing issues.37

States that have implemented reforms similar to the Partnership for a Healthy North Carolina have avoided this

problem by instituting prompt payment requirements for all health plan providers. KanCare, for example, includes

strict prompt payment requirements among its Year 1 performance measures.

38

KanCares benchmark requiresmanaged care organizations to process all clean claims within 20 days and 90 percent of all nursing facility claims

within 14 days.39KanCare withholds 3 to 5 percent of the capitated rates each year.40Plans will not receive those

funds if they do not meet payment and other performance benchmarks. 41

Louisianas Bayou Health requires managed care organizations to pay 90 percent of all clean claims within 15

business days and 99 percent of all clean claims within 30 calendar days.42If a claim is disputed, it must be sent to

an independent third party for review.43As a result, between 99.8 percent and 99.99 percent of all clean claims are

processed within 30 days, with average billing cycles ranging from 3.7 to 8.3 days.44,45,46


7/16

LESSONS LEARNED


thePartnershiPdeveLoPsstrongProvidernetworKsthroughthoughtfuLimPLementation

Another major problem Kentucky experienced during its transition to traditional managed care related to the

development of new provider networks.47A provider network is a group of physicians, specialists, hospitals, clinics

and other providers that contract with a CCE or managed care organization to deliver services to the organizations

members.

While the plans in Kentucky were able to secure letters of intent from providers, many doctors and hospitals

were unable to agree on nal contract terms before open enrollment.48In some cases, the letters of intent did not

result in actual contracts, leaving managed care organizations provider networks in ux.49

Most provider-network development problems stemmed from Kentuckys rapid transition. The legislation to

transition Kentuckys Old Medicaid program to managed care was enacted March 25, 2011.50The state issued a

request for proposals on April 7, 2011 and nalized the contracts with the three selected managed care organizations

on July 8, 2011.51,52This gave managed care organizations just four months from the time contracts were signed

until open enrollment began to establish operations in each of the regions of Kentucky they were contracted to

serve.53

Kentuckys timeline did not guarantee network development problems, of course. In KanCare, for example

open enrollment began just four months after nalizing contracts with the selected managed care organizations. 54

The difference between Kentucky and Kansas was in planning. Prior to selecting managed care organizations,

Kansas spent more than a year planning for the implementation of KanCare.55

Kansas created regular progress deadlines to help ensure provider networks would be ready in time for open

enrollment. The contracts included deadlines for approving provider agreements, deadlines for meeting readiness

benchmarks for contracting with the providers needed for each geographic region, deadlines for reporting al

contracted providers and deadlines to fully establish networks prior to KanCare launching in January 2013.5

Kansas also performed readiness reviews, document requests, on-site reviews and health plan audits in the period

leading up to open enrollment.57

North Carolina can prepare for implementation of the Partnership the way Kansas prepared for KanCare. The

Partnerships timetable helps ensure CCEs will have enough time to establish provider networks before open

enrollment begins. The North Carolina Department of Health and Human Services can spend the time leading up to

open enrollment holding multiple community and stakeholder meetings, as well as forming provider workgroups

to prepare for implementation activities and hosting regular operational status meetings.

North Carolinas Department of Health and Human Services welcomes collaboration, having already scheduled

numerous town hall events statewide to discuss Medicaid reform.58The reform process itself has been an exercise

Louisianas Bayou Health protects providers from payment delays

Source: Louisiana Department of Health and Hospitals


8/16

8


LESSONS LEARNED

in transparency and stakeholder input, beginning when the Department issued a request for ideas to improve the

Medicaid program.59Indeed, the entire framework of the Partnership for a Healthy North Carolina was developed

after months of working with more than 160 different providers, Medicaid patients and advocacy groups offering

input in the reform process.60

thePartnershiPfeaturesLeadershiPwiththeCritiCaLexPerienCeKentuCKyLaCKed

Kentuckys rapid implementation was further complicated by a lack of experience with managed care throughout

the states Medicaid agency. Senior state ofcials responsible for overseeing the new managed care program had

little exposure to managed care reforms and few received any training prior to implementation. 61State ofcials

lacked expertise in monitoring performance and utilizing tracked information to improve quality.

North Carolina has the benet of senior staff with a wide range of experience with managed care programs and

Medicaid reform. State ofcials have monitored quality and access for years. The state already tracks Medicaid

performance through Healthcare Effectiveness Data and Information Set (HEDIS) measures.62These metrics are

used by more than 90 percent of health plans in the United States to evaluate plan performance on cost-effectiveness

and health outcomes.63,64,65

Dr. Aldona Wos, secretary of the North Carolina Department of Health and Human Services, previously

experienced a difcult transition to managed care in New York State and is committed to ensuring North

Carolina does not replicate those same mistakes. Her background as a physician is another asset as she oversees

implementation of the Partnership.66

Carol Steckel, North Carolinas Medicaid director, has extensive state and national experience with Medicaid

reform. Steckel previously served in the U.S. Department of Health and Human Services and spent more than a

decade running Alabamas Medicaid program.67

Steckel has also served as the executive committee chairperson of the National Association of State Medicaid

Directors, as president of the National Association of Medicaid Directors, and as a fellow in the Robert WoodJohnson Foundations Medicaid Leadership Institute.68

She also previously directed the Center for Health Care Innovation and served as executive director of health

care reform, both at the Louisiana Department of Health and Hospitals, during implementation of Bayou Health,

Louisianas innovative, patient-centered Medicaid reform plan.69,70

The experience of senior staff will assist in redesigning North Carolinas Medicaid program to increase access

to needed care, improve patient health outcomes and make Medicaid budgeting more predictable.

thePartnershiPheLPsensuremanagedCareorganizationsCannothoLdthestatehostageLiKetheyCan

inKentuCKy

Kentuckys managed care program gives contracted managed care organizations too much leverage over the

state. Although the state received seven bids, it awarded just three statewide contracts.71One of these three plans

is now threatening to drop out of the program.72

Federal rules require patients have a choice of at least two plans. A plan threatening to leave has much greater

leverage over the state if that state only contracts with a total of two or three managed care organizations.73

Oklahoma experienced this in the mid-2000s. While operating the SoonerCare Plus program, Oklahoma

contracted with just a few managed care organizations, barely meeting the federal requirement that patients be


9/16

LESSONS LEARNED


given a choice of at least two plans.74Because Oklahoma did not maintain a robust marketplace of Medicaid plan

options, the few managed care organizations that received contracts from the state had enormous leverage over

taxpayers.

Oklahoma had to eventually cancel its managed care program altogether when one of the contracted managed

care organizations demanded an 18 percent rate increase.75Because that managed care organization was necessary

to meet the federal requirement that all patients be given at least two options, Oklahoma was forced to end theprogram.76

Florida and Louisiana have avoided this problem by creating a more robust Medicaid marketplace. Florida

divides its Medicaid population into eleven geographic regions, ranging from 100,000 to 600,000 enrollees per

region, with an average of four to six plans offered per region.77,78In Broward County, which has nearly 180,000

enrollees, Medicaid patients can choose from 13 different health plans.79Louisiana selected ve statewide options

for its 900,000 enrollees.80

The Partnership for a Healthy North Carolina calls for the state to contract with up to four comprehensive care

entities.81Four are needed to ensure robust competition, but with 1.5 million Medicaid patients, North Carolinas

Medicaid program has the economy of scale to attract signicant interest from even more plans. If North Caro-lina can expand the number of CCEs, the state will have more leverage over the CCEs, rather than the other way

around.

ConCLusion

Governor Pat McCrorys innovative Partnership for a Healthy North Carolina is blazing a trail toward pro-

patient, pro-taxpayer Medicaid reform. The proven strategies employed by the Partnership are likely to rein in

skyrocketing Medicaid spending and empower patients with greater control over their health future, better access

to specialists, and improved health outcomes.

These strategies have already worked in Florida, Kansas, and Louisiana, and are likely to work in NorthCarolina, too.

Not only has North Carolina learned what succeeds for patients and taxpayers in other states, it has also learned

what simply doesnt work. Looking closely at Kentuckys attempts at Medicaid managed care reform, and the

pitfalls that followed, the governor has taken common sense steps to avoid failure. The Partnership for a Healthy

North Carolina is truly a well-thought-out, pro-patient, pro-taxpayer Medicaid reform.


10/16

10


LESSONS LEARNED

Endnotes

1. For a detailed examination of North Carolinas current Medicaid program and the need for reform, see Jonathan Ingram and

Katherine Restrepo, The Partnership for a Healthy Carolina: Medicaid reform that works for patients, providers, and taxpayers

alike, John Locke Foundation (2013), http://johnlocke.org/acrobat/policyReports/Partnership.pdf.

2. For a detailed outline of the Partnership for a Healthy North Carolina, see Pat McCrory, Partnership for a Healthy North Carolina,

North Carolina Ofce of the Governor (2013), http://p1.governor.nc.gov/sites/default/les/partnershipforahealthynorthcarolina.pdf

3. For a detailed analysis of the Partnership for a Healthy North Carolina, see Jonathan Ingram and Katherine Restrepo, The Partnershipfor a Healthy Carolina: Medicaid reform that works for patients, providers, and taxpayers alike, John Locke Foundation (2013),

http://johnlocke.org/acrobat/policyReports/Partnership.pdf.

4. Ibid.

5. Travis Fain, North Carolina tackles Medicaid reform, News and Record (2013), http://www.news-record.com/home/1060841-63

nc-tackles-medicaid-reform.

6. Adam Linker, North Carolina does not need to be remade, Star News Online (2013), http://www.starnewsonline.com

article/20130414/ARTICLES/130419816.

7. Ashley Palmer et al., Evaluation of statewide risk-based managed care in Kentucky: A rst year implementation report, Urban

Institute (2012), http://www.urban.org/UploadedPDF/412702-Evaluation-of-Statewide-Risk-Based-Managed-Care-in-Kentucky

pdf.

8. Jill Midkiff and Gwenda Bond, Kentucky receives federal approval to implement Medicaid managed care, Kentucky Cabinet fo

Health and Family Services (2011), http://chfs.ky.gov/news/CMSapproval.htm.

9. For a complete list of populations and benets carved out of Kentuckys Medicaid managed care, see 907 Kentucky Admin. Reg

17:005, http://www.lrc.state.ky.us/kar/907/017/005.htm.

10. Department for Medicaid Services, Kentucky Medicaid managed care: About Medicaid managed care, Kentucky Cabinet fo

Health and Family Services (2013), http://medicaidmc.ky.gov/Pages/about.aspx.



pdf.

12. Ibid.

13. Ibid.

14. Ibid.

15. Pat McCrory, Partnership for a Healthy North Carolina, North Carolina Ofce of the Governor (2013), http://p1.governor.nc.govsites/default/les/partnershipforahealthynorthcarolina.pdf.

16. Kansas Department of Health and Environment, KanCare: Section 1115 demonstration application, Kansas Department of Health

and Environment (2012), http://www.kancare.ks.gov/download/KanCare_Section_1115_Demonstration_August_6_2012.pdf.

17. Ofce of Medicaid Management Information Systems Services, NCTracks: Frequently asked questions, North Carolina

Department of Health and Human Services (2013), http://ncmmis.ncdhhs.gov/faq.asp.

18. Ofce of Medicaid Management Information Systems Services, NC Medicaid Management Information System Plus program

Quarterly report to the North Carolina General Assembly, Nov. 2012 Jan. 2013, Appendix D, North Carolina Department of

Health and Human Services (2013), http://ncmmis.ncdhhs.gov/les/NCGA%20NCMMIS%20Program%20Rpt%20Append%20

D%20for%20Apr%201%202013.pdf.

19. Beth A. Wood, Performance audit: Department of Health and Human Services NCTracks (MMIS replacement) implementation,

North Carolina Ofce of the State Auditor (2013), http://www.ncauditor.net/EPSWeb/Reports/InfoSystems/ISA-2013-4410.pdf.

20. Beth A. Wood, Performance audit: Department of Health and Human Services Replacement MMIS implementation, NorthCarolina Ofce of the State Auditor (2012), http://www.ncauditor.net/EPSWeb/Reports/Performance/PER-2011-7273.pdf.

21. Ibid.

22. Beth A. Wood, Performance audit: Department of Health and Human Services NCTracks (MMIS replacement) implementation,

North Carolina Ofce of the State Auditor (2013), http://www.ncauditor.net/EPSWeb/Reports/InfoSystems/ISA-2013-4410.pdf.

23. Ibid.

24. Ibid.

25. Ibid.

26. Beth Musgrave, Complaints continue about delays in Medicaid payments, Lexington Herald-Leader (2012), http://www.kentucky

com/2012/12/11/2440057/complaints-continue-about-delays.html.


11/16

LESSONS LEARNED


27. Valarie Honeycutt Spears and Beth Musgrave, Appalachian Regional Healthcare sues Medicaid managed care companies,

Lexington Herald-Leader (2012), http://www.kentucky.com/2012/04/20/2158935/appalachian-regional-healthcare.html.



pdf.

29. John Cheves, Kentucky Spirit les lawsuit alleging state provided faulty Medicaid data, Lexington Herald-Leader (2012), http:/

www.kentucky.com/2012/10/23/2382085/kentucky-spirit-les-lawsuit.html.30. Stephenie Steitzer, Edelen makes recommendations to improve Kentuckys new Medicaid managed care system. Kentucky

Auditor of Public Accounts (2012), http://apps.auditor.ky.gov/Public/Audit_Reports/Archive/2012Medicaid-pr.pdf.

31. Ibid.

32. Ibid.

33. Kenny Colston, Greg Stumbo les bill aimed at speeding up Medicaids late payment process, 89.3 WFPL News (2013), http:/

wfpl.org/post/greg-stumbo-les-bill-aimed-speeding-medicaids-late-payment-process.

34. Kerri Richardson and Terry Sebastian, Billing trends since implementation, Kentucky Ofce of the Governor (2013), http://

governor.ky.gov/Press%20Release%20Attachments/20130405_FactSheet_BillingTrends.pdf.

35. An analysis of claims found that hospitals had billed the managed care organizations using the non-emergency code just once out o

all 644,000 emergency room visits. Reviews by the managed care organizations concluded that nearly 30,000 of those claims were

classied as non-emergencies. See, e.g., Kerri Richardson and Terry Sebastian, Billing trends since implementation, Kentucky

Ofce of the Governor (2013), http://governor.ky.gov/Press%20Release%20Attachments/20130405_FactSheet_BillingTrends.pdf

36. Kerri Richardson and Terry Sebastian, Gov. Beshear vetoes HB 5 but implements primary intent of bill, Kentucky Ofce of the

Governor (2013), http://migration.kentucky.gov/Newsroom/governor/20130405hb5.htm.

37. Ibid.



39. Ibid.

40. Ibid.

41. Ibid.

42. Bureau of Health Services Financing, Prepaid Coordinated Care Networks: RFP # #305PUR-DHHRFP-CCN-P-MVA, Louisiana

Department of Health and Hospitals (2011), http://dhh.louisiana.gov/assets/docs/Making_Medicaid_Better/RequestsforProposals

CCNPrepaid04112011_FINAL.pdf.43. Ibid.

44. In the most recently reported quarter, Louisiana Healthcare Connections paid 99.83 percent of all clean claims within 30 calendar

days and had an average billing cycle of 8.3 days. See, e.g., Bayou Health, Louisiana Healthcare Connections: Prompt paymen

report, Louisiana Department of Health and Hospitals (2013), http://dhh.louisiana.gov/assets/docs/BayouHealth/Publishable_

Reports/4thQuarter/221_LHC_2012_Q4.pdf.

45. In the most recently reported quarter, LaCare paid 99.99 percent of all clean claims within 30 calendar days and had an average

billing cycle of 3.7 days. See, e.g., Bayou Health, LaCare: Prompt payment report, Louisiana Department of Health and Hospital

(2013), http://dhh.louisiana.gov/assets/docs/BayouHealth/Publishable_Reports/4thQuarter/221_LAC_2012_Q4.pdf.

46. In the most recently reported quarter, Amerigroup paid 99.80 percent of all clean claims within 30 calendar days and had an average

billing cycle of 6.0 days. See, e.g., Bayou Health, Amerigroup: Prompt payment report, Louisiana Department of Health and

Hospitals (2013), http://dhh.louisiana.gov/assets/docs/BayouHealth/Publishable_Reports/4thQuarter/221_AMG_2012_Q4.pdf.

47. Ashley Palmer et al., Evaluation of statewide risk-based managed care in Kentucky: A rst year implementation report, UrbanInstitute (2012), http://www.urban.org/UploadedPDF/412702-Evaluation-of-Statewide-Risk-Based-Managed-Care-in-Kentucky

pdf.

48. Ibid.

49. Ibid.

50. Steven L. Beshear, Veto message from the Governor of the Commonwealth of Kentucky regarding House Bill 1 of the 2011 rs

extraordinary session, Kentucky Ofce of the Governor (2011), http://www.lrc.ky.gov/record/11ss/HB1/veto.pdf.

51. Ofce of Procurement Services, CHFS Medicaid Managed Care Organizations RFP: RFP-758-1100000276, Kentucky Finance

and Administration Cabinet (2011), http://dl.dropboxusercontent.com/s/217htquweb4p570/KY-RFP-758-1100000276.pdf.

52. Kerri Richardson and Terry Sebastian, Governor Beshears Medicaid plan to save taxpayers $1.3 billion, Kentucky Ofce of the

Governor (2013), http://migration.kentucky.gov/Newsroom/governor/20110707medicaid.htm.


12/16

12


LESSONS LEARNED



pdf.



55. Ibid.

56. Robert Moser et al., Shedding light on KanCare, Kansas Association for the Medically Underserved (2012), http://wwwkamuonline.org/assets/documents/conference/Shedding%20Light%20on%20KanCare.pdf.

57. Robert Moser and Kari Bruffett, KanCare readiness review process, Kansas Department of Health and Environment (2012)

http://www.kancare.ks.gov/download/KanCare_Readiness_Review_Process.pdf.

58. Richard Craver, Health and Human Services plans Triad meetings, Winston-Salem Journal (2013), http://www.journalnow.com

news/local/article_40b67d7a-b766-11e2-95c6-001a4bcf6878.html.

59. Division of Medical Assistance, Request for information: RFI-DMA-100-13, North Carolina Department of Health and Human

Services (2013), http://www.ncdhhs.gov/RFI_NC_DMA_Recommendations_Reforming_NCMedicaid.pdf.

60. Press Ofce, Governor McCrory announces Partnership for a Healthy North Carolina, North Carolina Ofce of the Governo

(2013), http://www.governor.nc.gov/newsroom/press-releases/20130403/governor-mccrory-announces-partnership-healthy-north

carolina.


Institute (2012), http://www.urban.org/UploadedPDF/412702-Evaluation-of-Statewide-Risk-Based-Managed-Care-in-Kentuckypdf.

62. North Carolina currently tracks 73 HEDIS measures for its Medicaid program. See, e.g., Division of Medical Assistance, DMA

HEDIS 2011 reporting: Comparisons and trends, North Carolina Department of Health and Human Services (2012), http://www

ncdhhs.gov/dma/quality/hedis2011_Reporting_Comparisons_Trends.xls.

63. National Committee for Quality Assurance, HEDIS and Quality Compass: What is HEDIS? National Committee for Quality

Assurance (2013), http://www.ncqa.org/HEDISQualityMeasurement/WhatisHEDIS.aspx.

64. Dennis P. Scanlon et al., The role of performance measures for improving quality in managed care organizations, Health Services

Research 36(3): 619-641 (2001), http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1089245.

65. Peter J. Neumann and Bat-Sheva Levine, Do HEDIS measures reect cost-effective practices? American Journal of Preventive

Medicine 23(4): 276-289 (2002), http://www.ajpm-online.net/article/S0749-3797(02)00516-0

66. Aldona Wos, Public input vital to Medicaid reform, Star News Online (2013), http://www.starnewsonline.com/article/20130414

ARTICLES/130419816.

67. Christine Vestal, Interview: A southern Medicaid Directors perspective on health care reform, Stateline (2013), http:/

www.pewstates.org/projects/stateline/headlines/interview-a-southern-medicaid-directors-perspective-on-health-care-

reform-85899456637.

68. World Congress, Speaker biography: Carol Steckel, World Congress (2012), http://www.worldcongress.com/speakerBio

cfm?speakerID=5862.

69. Julie Henry, Carol Steckel brings national and state experience to new role as N.C. Medicaid Director, North Carolina Departmen

of Health and Human Services (2013), http://www.ncdhhs.gov/pressrel/2013/2013-01-22_new_medicaid_director.htm.

70. Carol H. Steckel, How Louisiana achieved a Medicaid Cure, Louisiana Department of Health and Hospitals (2012), http://www

medicaidcure.org/wp-content/uploads/2012/09/How-Louisiana-Achieved-a-Medicaid-Cure_CAROL-STECKEL.pdf.


Institute (2012), http://www.urban.org/UploadedPDF/412702-Evaluation-of-Statewide-Risk-Based-Managed-Care-in-Kentuckypdf.

72. Jill Midkiff, Kentucky Spirit announces its intent to cancel Medicaid managed care contract one year early, Kentucky Cabinet for

Health and Family Services (2012), http://chfs.ky.gov/news/Contract+Termination.htm.

73. 42 C.F.R. 438.52.

74. James Verdier et al., SoonerCare 1115 waiver evaluation: Final report, Oklahoma Health Care Authority (2009), https://

dl.dropboxusercontent.com/s/mbx0pozqwm82pyp/6492_SoonerCare_Report_2009.pdf.






13/16

LESSONS LEARNED


77. Florida Agency for Health Care Administration, Florida Medicaid managed care and Medicaid pilot enrollment reports as of

March 1, 2013, Florida Agency for Health Care Administration (2013), http://www.fdhc.state..us/mchq/Managed_Health_Care

MHMO/docs/MC_ENROLL/Reform-NonReform_Plans/2013/ENR_Mar2013.xls.

78. Robert K. Bradford, Statewide managed medical assistance program: 1115 research and demonstration waiver, Florida Agency fo

Health Care Administration (2011), http://ahca.myorida.com/Medicaid/statewide_mc/pdf/mma/Amendment_1_1115_Medicaid_

Reform_Waiver_08012011.pdf.

79. Florida Agency for Health Care Administration, Florida Medicaid managed care and Medicaid pilot enrollment reports as ofMarch 1, 2013, Florida Agency for Health Care Administration (2013), http://www.fdhc.state..us/mchq/Managed_Health_Care

MHMO/docs/MC_ENROLL/Reform-NonReform_Plans/2013/ENR_Mar2013.xls.

80. Bruce D. Greenstein, Making Medicaid better: Lessons from Louisianas journey to managed care, Louisiana Department o

Health and Hospitals (2012), http://www.medicaidcure.org/wp-content/uploads/2012/10/Louisianas-Bayou-Health-Making

Medicaid-Better.pdf.

81. Pat McCrory, Partnership for a Healthy North Carolina, North Carolina Ofce of the Governor (2013), http://p1.governor.nc.gov

sites/default/les/partnershipforahealthynorthcarolina.pdf.


14/16

14


LESSONS LEARNED

abouttheauthors

Jonathan Ingramis the Director of Research at the Foundation for Government Accountability (FGA).

Before joining the FGA, Jonathan served as the Director of Health Policy and Pension Reform at the Illinois Policy

Institute, a non-partisan research organization dedicated to promoting personal freedom and prosperity in Illinois.While at the Institute, he developed public policy solutions, with a particular focus on patient-centered health care

policies and public sector retirement reform. Jonathan has also previously served as a staff writer and editor-in-chief

for the Journal of Legal Medicine, an internationally-ranked peer-reviewed academic journal.

Jonathans work has earned coverage from The Wall Street Journal, the Chicago Tribune, Crains Chicago Business,

the Washington Examiner and Fox Business News, among other media outlets.

Jonathan earned his Juris Doctor from Southern Illinois University School of Law, where he specialized in health

law and policy, and his Bachelor of Science from MacMurray College. He is licensed to practice law in the State of

Illinois.

Katherine Restrepois the Health and Human Services Policy Analyst at the John Locke Foundation.

Before joining the John Locke Foundation, she interned at the Cato Institute under the direction of Michael F. Can-

non, Director of Health Policy Studies. In Washington, D.C., she developed a strong interest in consumer-driven

health care and repeal of anti-constitutional provisions in the Patient Protection and Affordable Care Act.

Katherine graduated Phi Beta Kappa from McDaniel College with a Bachelors of Arts in Political Science and Span-

ish along with a minor in Communication.

A former collegiate athlete, Katherine enjoys playing basketball, golf, and running in her spare time and continues to

play the violin.


15/16

LESSONS LEARNED


abouttheJohnLoCKefoundation

The John Locke Foundation is a nonprot, nonpartisan policy institute based in Raleigh. Its mission is to develop

and promote solutions to the states most critical challenges. The Locke Foundation seeks to transform state and local

government through the principles of competition, innovation, personal freedom, and personal responsibility in orderto strike a better balance between the public sector and private institutions of family, faith, community, and enterprise

To pursue these goals, the Locke Foundation operates a number of programs and services to provide information

and observations to legislators, policymakers, business executives, citizen activists, civic and community leaders, and

the news media. These services and programs include the foundations monthly newspaper, Carolina Journal; its daily

news service, CarolinaJournal.com; its weekly e-newsletter, Carolina Journal Weekly Report; its quarterly newslet-

ter, The Locke Letter; and regular events, conferences, and research reports on important topics facing state and loca

governments.

The Foundation is a 501(c)(3) public charity, tax-exempt education foundation and is funded solely from voluntary

contributions from individuals, corporations, and charitable foundations. It was founded in 1990. For more informa-

tion, visit www.JohnLocke.org.


16/16

200 West Morgan St., #200

Raleigh, NC 27601

V: 919-828-3876

F: 919-821-5117

www.johnlocke.org

[email protected]

To prejudge other mens notions

before we have looked into them

is not to show their darkness

but to put out our own eyes.

JOHN LOCKE (16321704)

Author, Two Treatises of Governmentand Fundamental Constitutions ofCarolina

Policy Report Lessons Learned: How the Partnership for a Healthy North Carolina Avoids Kentucky’s Medicaid Reform Mistakes

Documents